TransCare Ambulance, which partnered with New York City Fire Department (FDNY) to provide ambulance service in the Bronx and Manhattan, filed for bankruptcy this week. The city must now cover 81 daily ambulance tours to ensure seamless service in the affected areas.¹ FDNY will manage the sudden loss of service by filling additional tours on overtime. This strategy is temporary and may further strain an agency that is dealing with rising demand for medical service and slower response times. But FDNY can implement a more comprehensive approach by reallocating existing resources.

As highlighted in our December 2015 report, FDNY’s workload was 75 percent medical incidents and just 5 percent fire incidents. Yet the agency’s budget is skewed towards fire extinguishment and emergency response; 56 percent of funding is spent on fire operations compared to 28 percent spent for medical service. Fundamental changes are needed to realign the agency to match current service needs. The department’s leadership recognizes this and has proposed a pilot program to have SUVs staffed by two paramedics respond to urgent medical calls more quickly.²  

The Department can go further to implement common sense solutions toward boosting medical response capacity:

1. Modify Advanced Life Support (ALS) ambulance staffing to one paramedic and one emergency medical technician (EMT) for more efficient response. FDNY has petitioned the New York City Regional Emergency Medical Service Council (REMSCO) in the past to modify ALS ambulance staffing from two paramedics to one paramedic and one EMT. The change would not diminish the quality of care and would yield and estimated $5 million in savings annually, which could be reinvested to increase the number of ambulance tours. The agency should do so once again and REMSCO should approve the petition.
2. Increase medical training for firefighters, allowing them to handle more emergencies without reliance on a subsequent ambulance and its staff. Requiring firefighters to carry EMT certification is a common practice in major U.S. cities including Chicago, Houston, Phoenix, and San Francisco. If firefighters held EMT certification, some medical incidents to which engine companies are dispatched could be handled without waiting for subsequent ambulance backup. Calls which do not require transport could be handled by firefighters alone, without requiring an ambulance unit. This staffing arrangement would eliminate redundancy and alleviate some of the pressure on the Emergency Medical Service (EMS).

The trend toward increasing medical calls will continue as the City’s population increases and residents age. Filling ambulance tours on overtime is analogous to treating a serious medical condition with a temporary bandage. Future strategies to increase EMS capacity should be more extensive and more creative. The loss of TransCare service is a challenge the Department can manage; but it also provides an opportunity to reexamine FDNY’s structure and operations and to consider innovative solutions to streamline emergency medical services and fire operations.

Read more about FDNY’s changing workload and proposed solutions here.